Scaphoid Fracture Treatment

Treatment of a Scaphoid fracture with a Capacitively Coupled Electric Field using the Matrix II

Introduction of scaphoid fracture case

Scaphoid fracture is a common injury of the wrist in athletes which frequently goes undiagnosed for a period of time and not uncommonly, despite good orthopaedic management, goes on to delayed or non-union. Treatment of scaphoid non-union presently includes ongoing immobilization, bone grafting, various internal fixators, and combinations of these (4.). Ultimately it may become necessary to insert a prosthetic scaphoid. To this therapeutic armamentarium has recently been added the use of pulsing electromagnetic fields (3.) and capacitively coupled electric fields(2.); both of which methods claim a high rate of success. One report has suggested that the combined use of a bone graft plus electrical stimulation has a higher rate of success than either method alone (5.,6.). The case presented here was initially diagnosed three months following fracture, was grafted, internally fixated and casted and which nevertheless failed to unite. A trial of capacitively coupled electrical stimulation was instituted and the fracture united. The imaging films show the progress of bone development over one year.

Scaphoid Fracture Case History

R.W. is a 29 year old white male who fell playing soccer on Dec. 15, 1989 injuring his left wrist. Because of ongoing pain a radiogram was taken March 15, 1990, which revealed a clear fracture line through the waist of the scaphoid with no evidence of callus formation. On examination the orthopaedic surgeon found pain, tenderness, and stiffness in the affected wrist. He proceeded to do a Russe bone graft and fixated the fracture with a C-pin, after which the patient was placed in an above elbow scaphoid plaster.

On May 14, 1990, repeat radiograms revealed a clearly evident fracture and sclerosis of the proximal fragment. Repeat films taken June 25, 1990, again revealed a clearly evident fracture and sclerosis of the proximal fragment. The orthopaedic surgeon felt this represented a failure of surgical management and elected to use electrical stimulation, which was begun on July 5, 1990. Check films taken October 2, 1990, along with tomograms demonstrate nearly complete obliteration of the fracture line, although some proximal sclerosis persists. The cast was removed and electrical stimulation discontinued. On November 23,1990, plain films and tomograms revealed ongoing bony union. On December 3, 1990 the pin was removed. The follow up films of March 13, 1991 revealed a deformity of the scaphoid as a result of the fracture, which was solidly united.

Scaphoid Fracture Treatment Discussion

This case features delayed diagnosis and a failure of surgical management. Despite good orthopaedic treatment, the fracture had failed to heal. This single case indicates that capacitively coupled electrical stimulation may have a role as adjunctive therapy in difficult scaphoid fractures. Osterman, et al, state in their review article of scaphoid non-union (1.) that the most appropriate indication for the use of electrical stimulation is in those patients who have failed the previous bone grafting and in whom the scaphoid has remained relatively aligned.